In 1958 there were only 3 renal units operating in the UK, at Leeds, Hammersmith, and RAF Halton. The Leeds unit had been the first, using a modified version of the original Kolff dialysis machine, but the other two units had newer technology made by Travenol with Kolff's help - a machine that looked rather like a washing machine, but was more controllable and used disposable artificial kidneys (coils), a first. 1959 was the beginning of a boom, with new units opening in Edinburgh, Glasgow, Newcastle, Belfast and the London hospital. You can read a 1958 Report on the United Kingdom Artificial Kidney Units at www.edren.org. This led to the purchase of a Kolff-Travenol device.
Dr Frank Parsons had worked in Boston and in 1956 managed to persuade his Leeds hospital managers, and the Medical Research Council, to give dialysis a second go using the Brigham (Boston) Hospital modified version of the Kolff dialysis machine.
There was considerable resistance. Early experience in the UK with one of Kolff's unmodified machines at Hammersmith had been widely regarded as unsuccessful, despite the positive spin put on it in the 1948 paper by Bywaters and Joekes. Eminent physicians believed that it was a barbaric treatment with results no better than could be achieved by conservative fluid and dietary management, the 'Bull' regimen. However the experience in the Korean war with Kolff-Brigham machines had been more positive, and in Scandinavia Nils Alwall had an even more effective machine in use since 1946. Newcastle chose his machine. An English pathologist and clinician Michael Darmady made his own improvements to the basic Kolff design and treated a number of patients in Wiltshire from 1947-48, but there was no haemodialysis in the UK between 1948 and 1956.
However by 1959 dialysis was becoming accepted as a treatment for acute renal failure in a number of countries, and Britain was playing catch up. Perhaps one of the reasons for its slow uptake becomes clear from the Edinburgh report on their recommended machine:
"The Kolff-Travenol Artificial Kidney with disposable coils and incorporating ultra filtration and dialysis is the machine which combines the most advantages. Its simplicity of preparation and operation and its intrinsic safety are outstanding. It has the additional advantage of relative cheapness. For the operation of dialysis two doctors and two nurses are required. One of the nurses should be senior and preferably have operating theatre experience. One other member of the medical staff should be able to run the machine. A full time biochemical technician is necessary. The room in the Clinical Laboratory suggested for the artificial kidney when suitably equipped, would be adequate for the purpose."
So a single dialysis on one patient involved two doctors, two nurses, and a biochemistry technician. It began with a cut-down onto an artery and vein, which were tied off after a single treatment lasting 6-8 hours. Such treatment was not cheap or simple - and the disposable coils were very expensive for the era.
Edinburgh's first patient was treated in May 1959, then again 3 days later, and survived. In the first year 65 dialyses were undertaken on 50 patients. Early reviews of results showed mortality of about 50%, similar to today, but these were a very different group of patients. They were young, they did not have multi-organ failure, and their diagnoses were mismatched blood transfusions, antibiotic toxicity (often crystallization), poisoning, post-surgical renal failure, and sepsis following illegal abortions.
What of acute peritoneal dialysis? And of dialysis for chronic renal failure? Stories for another time.
J. Stewart Cameron 2002. A History of the Treatment of Renal Failure by Dialysis (OUP)
The early history of dialysis (Edren)
This article is due to appear in the Journal of Renal Nursing in May 2009.